Testosterone in Perimenopause and Menopause Info

How Testosterone Changes Over Time

Testosterone levels peak in a woman's 20s and start declining around age 30, with a more noticeable drop during perimenopause and menopause. By menopause, levels can be about a quarter of their peak. This decline is gradual but can contribute to hormonal imbalances, especially alongside falling estrogen and progesterone. Factors like ovarian aging, stress, and medications can accelerate this.

Symptoms of Low Testosterone

Low testosterone can manifest in various ways, often overlapping with other menopausal symptoms. Common signs include:

- Low libido: Reduced sexual desire, arousal, or pleasure.

- Fatigue and low energy: Feeling constantly tired or lacking stamina.

- Muscle weakness and loss of tone: Decreased strength, muscle mass, or difficulty building muscle.

- Mood changes: Anxiety, irritability, depression, or low mood.

- Cognitive issues: Brain fog, memory loss, or trouble concentrating.

- Other physical symptoms: Weight gain, insomnia, hot flashes, vaginal dryness, joint pains, thinning hair, or bone loss.

These symptoms may not solely be due to low testosterone, so testing is essential.

What Improves When Testosterone is Corrected

Testosterone therapy, often as part of hormone replacement therapy (HRT), can address deficiencies and improve several areas:

- Sexual health: Enhanced libido, arousal, orgasm, and reduced distress about sex.

- Energy and vitality: Increased energy, reduced fatigue, and better overall well-being.

- Muscle and bone health: Improved muscle tone, strength, and bone density. Testosterone is the only hormone that builds bone. Estrogen maintains bone.

- Mood and cognition: Better mood, reduced anxiety/irritability, improved sleep, and sharper cognitive function.

- Other benefits: Potential anti-inflammatory effects, cardioprotection, neuroprotection, and relief from vulvovaginal symptoms.

Benefits are most evident in postmenopausal women with low libido, but evidence for premenopausal use is limited. Therapy is typically transdermal (gels, creams) for better safety.

Ideal Range of Testosterone

Testosterone levels vary by age, lab, and measurement method (total vs. free). For women:

- Pre-menopause/perimenopause: Total testosterone: 9-55 ng/dL (or 0-55 ng/L in some units).

- Post-menopause:Total testosterone: 0-40 ng/L, or often below 30 pg/mL.

Therapy aims to restore levels to the normal physiological range for women, often targeting levels from our 20’s or levels from our 30s.  Regular blood tests monitor this; symptoms guide adjustments more than numbers alone.

Potential Side Effects

While generally safe at low doses, testosterone therapy can cause:

- Androgenic effects: Acne, oily skin, increased facial/body hair (hirsutism), or scalp hair loss.

- Voice and physical changes: Deepening voice (rare, usually reversible at low doses).

- Metabolic issues: Weight gain, fluid retention, changes in lipid profile (e.g., lower HDL cholesterol), or edema. This is usually only noted initially and levels out over time.

- Other: Mood changes like anxiety, or rare risks if doses are too high (e.g., clitoral enlargement). I have only seen this in supraphysiologic doses in women transitioning.

Side effects are often mild, reversible, and less common with transdermal vs. oral forms. They're higher without concurrent estrogen therapy. Monitoring and dose adjustments minimize risks.

Tips for Managing Testosterone Levels

- Get tested: Blood work for total/free testosterone, especially if symptomatic.

- Lifestyle support: Strength training, balanced diet, stress management, and adequate sleep can help maintain levels naturally.

- Consider therapy: Discuss bioidentical options with your doctor; combine with estrogen/progesterone if needed.

- Track symptoms: Use a journal to monitor changes.

This info sheet is for educational purposes only. Seek professional medical advice for diagnosis or treatment.